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what medications are indicated in CAD/

Answer

The medical management of coronary artery disease (CAD) involves several classes of medications, each with specific indications based on patient characteristics and clinical presentation.

Antiplatelet therapy

Anticoagulant therapy

  • Rivaroxaban: Low-dose rivaroxaban 2.5 mg BID may be added to aspirin 81 mg daily for long-term reduction of risk for major adverse cardiovascular events in patients with chronic coronary disease with no indication for therapeutic direct oral anticoagulant (DOAC) or DAPT and at high risk of recurrent ischemic events but low-to-moderate bleeding risk

Beta-blockers

  • Indications: Beta-blockers reduce the risk of future major adverse cardiovascular events, including cardiovascular death, in patients with chronic coronary disease and left ventricular ejection fraction (LVEF) ≤ 40% with or without previous myocardial infarction . They are also recommended in patients with chronic coronary disease and LVEF < 50%
  • Reassessment: The indication for long-term (>1 year) use of β-blockers should be reassessed in patients on β-blocker therapy for previous myocardial infarction without a history of or current LVEF ≤ 50%, angina, arrhythmias, or uncontrolled hypertension

RAAS inhibitors

  • ACEIs or ARBs: ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) reduce cardiovascular events in patients with chronic coronary disease who also have hypertension, diabetes, LVEF ≤ 40%, or chronic kidney disease (CKD)

Antihypertensive therapy

  • ACEIs, ARBs, or β-blockers: These are recommended as first-line therapy for compelling indications (such as recent myocardial infarction or angina) in adult patients with chronic coronary disease and hypertension (systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg), in addition to nonpharmacological strategies

Statins

In conclusion, the choice of medication in CAD is guided by the patient's clinical profile, risk factors, and specific clinical scenario. The goal is to reduce the risk of major adverse cardiovascular events while minimizing the risk of adverse effects.

References

1

Coronary artery disease

Medical management

Guidelines

Beta-blockers

Pathway
ACC/.../PCNA 2023